Provider Demographics
NPI:1790274744
Name:SOHA, SETH GRIFFIN
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:GRIFFIN
Last Name:SOHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4918 W LEGACY SPRINGS DR APT 1119
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7395
Mailing Address - Country:US
Mailing Address - Phone:801-554-1915
Mailing Address - Fax:
Practice Address - Street 1:3665 S 8400 W STE 110
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4907
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10704566-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant